Should all children admitted with community acquired pneumonia have blood cultures taken?

Abstract

To evaluate the yield of blood cultures and the impact of blood culture results on the adjustment of empiric antibiotic treatment in children hospitalised with community acquired pneumonia (CAP). This was a prospective study conducted at a tertiary hospital in Malaysia, from 1st August 2010 until 31st July 2011. Children aged between 1mo and 12y who were admitted for CAP and had blood cultures performed before starting intravenous antibiotics were recruited. Children with congenital pneumonia, immunodeficiency, chronic cardiac or respiratory disorders, nosocomial pneumonia or those on corticosteroids, were excluded. Decision for admission was made by the attending Accident and Emergency physician. One hundred and seventy-one children were enrolled. The median age was 13mo (range: 38d-10y 3mo) and 59% were males. Blood cultures were positive in 1.2% (2/171) of patients while the contamination rate was 1.8% (3/171). Doctors altered antibiotics based on blood culture results in only one patient. Both the yield and the impact of blood culture results on the adjustment of empiric antibiotic treatment were very small. There was a high contamination rate. The recommended practice of performing blood cultures in all children admitted with CAP should be reviewed.